Effect of obstructive sleep apnea on the effectiveness of cognitive-motor training in patients with mild vascular cognitive impairment: a prospective comparative study

Background. Cognitive rehabilitation in patients with vascular cognitive impairment (VCI) remains challenging, particularly in the presence of comorbid conditions. obstructive sleep apnea syndrome (OSAS) is one of underestimated factor potentially limiting the effectiveness of cognitive interventions. Cognitive-motor training (CMT), including nondominant hand writing, is considered a promising non-pharmacological intervention; however, its efficacy in patients with combined VCI and OSAS has not been adequately studied. The aim. To compare cognitive performance dynamics in patients with moderate VCI depending on the presence of moderate to severe OSAS after a one-month course of nondominant hand writing training. Methods. A prospective non-randomized comparative interventional study was conducted from May 2024 to February 2025. The study included 34 patients aged 50–74 years with moderate VCI, divided into two groups based on the presence of moderate/ severe OSAS (AHI ≥ 15 events/hour). The intervention consisted of a 4-week CMT course (14 days inpatient, 14 days home-based). Cognitive performance was assessed before and after the intervention using the MoCA, FAB, FCSRT-IR, TMT, Stroop, and SDMT scales. Results. The study group included 16 patients with AHI ≥ 15 events/hour; the control group consisted of 18 patients with AHI < 15. The groups were comparable in age, sex, and comorbidities (p > 0,05). Both groups showed cognitive improvement post-intervention, but changes were more pronounced in the control group. Between-group comparisons of change scores revealed significant differences in Stroop 3 (p < 0,001; d = -1,18), TMT-B (p = 0,004; d = 1,08), SDMT (p = 0,160; d = -0,50), and FCSRT-IR FR (p < 0.001; d = -1,54). No adverse events were observed. Conclusion. The presence of moderate to severe OSAS reduces the effectiveness of nondominant hand writing training in patients with moderate VCI. These findings highlight the importance of accounting for sleep-disordered breathing when planning cognitive rehabilitation strategies.